Sexual orientation differences in Swedish young adults’ mental health service use and unmet needs

BACKGROUND: Sexual orientation differences in mental health service (MHS) use have been described before, but evidence from European settings is scarce, and little is known about unmet mental health needs (UMHN). This study examines sexual orientation differences in MHS use and UMHN and associated sociodemographic factors in a population-based sample of young adults in Sweden (aged 17-34). METHODS: We used data from the Pathways to Longitudinally Understanding Stress (PLUS) study (N = 2,126). We performed logistic regressions to model MHS use and UMHN, followed by a subgroup analysis of UMHN among those perceiving a need of MHS. We used interaction terms to understand if associations with sociodemographic factors (gender, age, educational level, income, employment status, household composition, urbanicity and country of birth) differed by sexual orientation and calculated expected proportions. RESULTS: Overall, 35% of sexual minorities had used MHS the previous year, compared to 20.2% of heterosexuals (OR = 1.52, 95%CI=1.17-1.96, p = 0.002). MHS use was more likely among females, those not employed, not living with a partner, or with low income and less likely for those with less education. UMHN were more likely among sexual minorities (17.6%) than heterosexuals (11.8%, OR = 1.47, 95%CI=1.09-2.00, p = 0.013). Overall, one-third of those with perceived need did not use services, with a significant interaction (p = 0.015) between sexual minority status and gender (60% of sexual minority males vs 36% of heterosexual males and 28% of sexual minority females). For both groups, UMHN were more likely among younger, low-educated and employed persons, and less likely among those with low income. CONCLUSIONS: Sexual minorities are more likely to use MHS but present higher access barriers. Sexual minority men seem less likely to seek help for mental health symptoms. Future research should assess why that happens, while policies should promote friendly mental health services to this group.